{
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"OrgName": "CENTRAL VALLEY CARDIOVASCULAR ASSOCIATES INC",
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 7065",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STOCKTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95267-0065",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-942-1005",
"MailingAddressFaxNumber": "209-239-7842",
"FirstLinePracticeLocationAddress": "1148 NORMAN DR",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "MANTECA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95336-5961",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-942-1005",
"PracticeLocationAddressFaxNumber": "209-239-7842",
"EnumerationDate": "10/09/2012",
"LastUpdateDate": "02/21/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EMANI",
"AuthorizedOfficialFirstName": "VENKATA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "209-465-0123",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RC0000X",
"TaxonomyName": "Cardiovascular Disease Physician",
"LicenseNumber": "A80313",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}